Journal of Gastrointestinal Surgery

, Volume 16, Issue 5, pp 967–976

Surgical Treatment of Type 2 Diabetes in Patients with BMI Below 35: Mid-term Outcomes of the Laparoscopic Ileal Interposition Associated with a Sleeve Gastrectomy in 202 Consecutive Cases

  • Aureo L. DePaula
  • Alessandro R. Stival
  • Carolina C. L. DePaula
  • Alfredo Halpern
  • Sergio Vencio
Original Article

DOI: 10.1007/s11605-011-1807-0

Cite this article as:
DePaula, A.L., Stival, A.R., DePaula, C.C.L. et al. J Gastrointest Surg (2012) 16: 967. doi:10.1007/s11605-011-1807-0

Abstract

Background

The objective of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition into the jejunum (JII-SG) or into the duodenum (DII-SG) associated with sleeve gastrectomy for type 2 diabetes mellitus (T2DM) patients with BMI below 35.

Methods

The procedures were performed on 202 consecutive patients. Mean age was 52.2 ± 7.5. Mean duration of T2DM was 9.8 ± 5.2 years. Insulin therapy was used by 41.1%. Dyslipidemia was observed in 78.2%, hypertension in 67.3%, nephropathy in 49.5%, retinopathy in 31.2%, coronary heart disease in 11.9%, and other cardiovascular events in 12.9%.

Results

Mean follow-up was 39.1 months (range, 25–61). Early and late mortality was 0.99% and 1.0%, respectively. Early reoperation was performed in 2.5%. Early and late major complications were 8.4% and 3.5%. Early most frequent complications were pneumonia and ileus. Intestinal obstruction was diagnosed in 1.5%. Mean BMI decreased from 29.7 to 23.5 kg/m2, mean fasting glucose from 202.1 to 112.2 mg/dl, and mean postprandial glucose from 263.3 to 130 mg/dl. Triglycerides diminished from a mean of 273.4 to 110.3 mg/dl and cholesterol from a mean of 204.7 to 160.1 mg/dl. Hypertension was resolved in 87.5%. Mean hemoglobin A1c (HbA1c) decreased from 8.7 to 6.2% after the JII-SG and to 5.9% following the DII-SG. HbA1c below 7% was seen in 89.9% of the patients and below 6.5% in 78.3%. Overall, 86.4% of patients were off antidiabetic medications.

Conclusion

Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI <35. Beyond glycemic control, other benefits were achieved.

Keywords

Type 2 diabetes Ileal interposition Sleeve gastrectomy Metabolic surgery Surgical treatment of diabetes 

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Aureo L. DePaula
    • 1
  • Alessandro R. Stival
    • 1
  • Carolina C. L. DePaula
    • 2
  • Alfredo Halpern
    • 3
  • Sergio Vencio
    • 2
  1. 1.Department of SurgeryHospital de EspecialidadesGoiâniaBrazil
  2. 2.Catholic University of GoiásGoianiaBrazil
  3. 3.Department of EndocrinologyUniversity of Sao PauloSao PauloBrazil